2019 Wumba Kids Camp

Please Note: There are duplicate programs offered in weeks one and two; three, four and five; six and seven. If your child is attending for more than one week, registration is permitted for just one week of each session to provide a fresh, stimulating program. To register for multiple children, please proceed with this registration for one child, and upon submission click back in your browser to the WMB website where you may proceed with further sign-ups. To pay online, just right-click the link at the bottom of this form to open it in a new tab and then click the green submit button on this form. If you prefer another payment method, please mail a cheque to WMB Church, do an e-transfer give@wmbchurch.ca (please indicate that it's a Wumba payment in the notes) or drop by the Waterloo church office to pay by cash, debit or credit card .




CAMPER'S INFORMATION
First Name of Camper
Last Name of Camper
Birth date: (mm/dd/yyyy)
Grade as of September 2019:
Gender:
If you regularly attend Sunday services, please tell us where:
Have you been to Wumba Kids Camp before?
If yes, what was a highlight from your previous summer with us?
If no, how did you hear about Wumba?
Buddy camper request: If your child is registering for Wumba with a friend, please indicate his/her name here (one name only, please) and we'll make an effort to ensure they're together
FAMILY INFORMATION
1. PRIMARY PARENT/GUARDIAN (This is the first contact in case of emergency)
First Name of Parent/Guardian
Last Name of Parent/Guardian
Address (If applicable, please include apartment #)
City
Province
Postal Code
Email Address (This is our primary way to communicate)
Phone Number
2. SECONDARY PARENT/GUARDIAN (This is the SECOND contact in case of emergency)
If there is not a second parent, leave this section blank
Name
Address if it differs from Primary Parent/Guardian
Home Phone if it differs from Primary/Guardian
Cell Phone if it differs from Parent/Guardian
Email if it differs from Primary Parent/Guardian
3. WHICH PARENT/GUARDIAN SHOULD RECEIVE WUMBA-RELATED EMAILS?
4. ALTERNATE EMERGENCY CONTACT (in case parental contacts cannot be reached)
Name
Phone
Medical Information
NOTE: We are not staffed for individual accessibility/inclusion needs.
Child's Health Card #:
HEALTH ISSUES: Please provide details regarding any health issues such as food or drug allergies, current medication, and medical conditions (vision or hearing loss, asthma, seizures, diabetes, mobility, etc) below

Is this health issue a "Life Threatening Allergy or Condition"?
Social Information
NOTE: We are not staffed for individual accessibility/inclusion needs.
Please indicate any social or legal information that will help us care for your child (custody orders, family situations, social behaviours, learning disabilities, etc.)

Consents
PICTURE CONSENT: Understanding that WMB does not include the names of minors with their pictures in any promotional material, I consent to the use of pictures/videos taken of my children at activities and events, for website, promotional and reporting purposes.
MEDICAL CONSENT: I consent to let program leaders seek medical attention for my child if I cannot be reached and immediate attention is deemed by the program leaders to be required. I understand that the leaders will make every effort to continue to contact me in the event of such a medical emergency.
DATA CONSENT: I consent that the information provided through this registration may be added to the WMB Church database to be used for church program purposes only, and not to be distributed to any outside party.
In lieu of paper, submission of this registration implies an electronic signature
Payment
I am registering this camper for:
Session One
Session Two (Note: Week 5 is held at our KITCHENER location)
Session Three
The cost for one week at camp is $100/child. If you are unable to pay the full amount, please indicate the amount you are able to contribute.
For each week this camper is registered I will pay:
If other, please indicate the amount you are able to contribute

To pay by credit card, CLICK THIS LINK and follow the instructions on the payment page, THEN CLICK THE GREEN SUBMIT BUTTON on this page to finalize your registration.
To pay using another method, click the green submit button on this page, and then: a) mail a cheque to the WMB Church Office (245 Lexington Rd, Waterloo, N2K 2E1), or b) pay by cash, debit or credit card in person at the Waterloo WMB Church Office during office hours (Monday – Friday, 9am-4pm) or c.) do an e-transfer with a note indicating it's a Wumba payment to give@wmbchurch.ca


Are Required Fields